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General NPI Number Information
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NPI Number | 1851709810
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Entity Type | Individual
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Provider Name | GABLE K HOLDERNESS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2845 GREENBRIER RD
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City | GREEN BAY
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State | WI
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Zip | 54311-6519
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Country | US
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Telephone | 920-288-4848
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Fax |
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Provider Business Mailing Address
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Address Line | 164 N BROADWAY
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City | GREEN BAY
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State | WI
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Zip | 54303-2728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6006-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6006-33
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License Number State | WI
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